| (a) Format and submission. Designated doctor narrative
reports must be filed in the form and manner required by the division.
At a minimum, they must do all of the following:
(1) Identify the question or questions the division
ordered to be addressed by the designated doctor examination.
(2) Provide a clearly defined answer for each question
to be addressed by the designated doctor examination and only for
each of those questions.
(3) Sufficiently explain how the designated doctor
determined the answer to each question within a reasonable degree
of medical probability.
(4) Demonstrate, as appropriate, application or consideration
of the American Medical Association Guides to the Evaluation of Permanent
Impairment, division-adopted return-to-work and treatment guidelines,
and other evidence-based medicine, if available.
(5) Include general information about the identity
of the designated doctor, injured employee, employer, treating doctor,
and insurance carrier.
(6) State the date of the examination and the address
where it took place.
(7) Summarize any additional testing conducted or referrals
made as part of the evaluation, including:
(A) the identity of any health care providers to which
the designated doctor referred the injured employee under §127.10(c)
of this title (relating to General Procedures for Designated Doctor
Examinations);
(B) the types of tests conducted or referrals made;
(C) the dates the testing or referral examinations
occurred;
(D) an explanation of why the testing or referral was
necessary to resolve a question at issue in the examination; and
(E) the date the testing or referral examination was
completed.
(8) Include a narrative description of the medical
history, physical examination, and medical decisions the designated
doctor made, including the time the designated doctor began taking
the medical history of the injured employee, physically examined the
employee, and engaged in medical decision making, and the time the
designated doctor completed these tasks.
(9) List the specific medical records or other documents
the designated doctor reviewed as part of the evaluation, including
the dates of those documents and which medical records were provided
by the injured employee.
(10) Provide the total amount of time required for
the designated doctor to review the medical records.
(11) Be signed by the designated doctor who performed
the examination.
(12) Include a statement that there is no known disqualifying
association as described in §127.140 of this title (relating
to Disqualifying Associations) between the designated doctor and the
injured employee, the injured employee's treating doctor, the insurance
carrier, the insurance carrier's certified workers' compensation health
care network, or a network established under Labor Code Chapter 504.
(13) Certify the date that the report was sent to all
recipients as required and in the manner required by §127.10
of this title.
(14) Indicate on the report that the designated doctor
reviewed and approved the final version of the report.
(b) Additional forms required. Designated doctors who
perform examinations under §127.10(d) or (e) of this title must
also complete and file the division forms required by those subsections
with their narrative reports. Designated doctors must complete and
file these forms in the manner required by applicable division rules.
(c) Designated doctor examination data report. Designated
doctors who perform examinations under §127.10(f) of this title
must, in addition to filing a narrative report that complies with
subsection (a) of this section, also file a designated doctor examination
data report in the form and manner required by the division. A designated
doctor examination data report must:
(1) include general information regarding the identity
of the designated doctor, injured employee, insurance carrier, as
well as the identity of the certified workers' compensation health
care network under Insurance Code Chapter 1305, if applicable, or
whether the injured employee is receiving medical benefits through
a political subdivision health care plan under Labor Code §504.053(b)(2)
and the identity of that plan, if applicable;
(2) identify the question or questions the division
ordered to be addressed by the designated doctor examination;
(3) provide a clearly defined answer for each question
to be addressed by the designated doctor examination and only for
each of those questions. For extent of injury examinations, the designated
doctor should also provide, for informational purposes only, a diagnosis
code for each disputed injury;
(4) state the date of the examination, the time the
examination began, and the address where the examination took place;
(5) list any additional testing conducted or referrals
made as part of the evaluation, including the identity of any healthcare
providers to which the designated doctor referred the injured employee
under §127.10(c) of this title, the types of tests conducted
or referrals made and the dates the testing or referral examinations
occurred; and
(6) be signed by the designated doctor who performed
the examination.
|
| Source Note: The provisions of this §127.220 adopted to be effective September 1, 2012, 37 TexReg 5422; amended to be effective November 4, 2018, 43 TexReg 7149; amended to be effective April 30, 2023, 48 TexReg 2123 |
